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CHIP: States Work to Increase Enrollment

Two years after CHIP was implemented in most states, 11 million children remain uninsured -- a slight increase over the 10.8 million children that were uninsured before the program started. Lawmakers, CHIP state officials, and policymakers are left wondering why the program has failed to stem the tide of the uninsured and how they can boost enrollment. At a seminar Tuesday hosted by the Alliance for Health Reform, experts discussed the progress in enrolling uninsured children. Ed Howard, executive vice president for the Alliance, called the high numbers of uninsured children "unacceptable," as almost 75% of them are eligible for some form of health insurance, either through CHIP or Medicaid.

Counting Errors One explanation for the rise in uninsured children might be that the numbers are faulty. Jennifer Baxendell, a Senate Finance Committee staff member, noted that new data HCFA hopes to release by the end of the year might show higher enrollment. In 1999 Congress made several adjustments to the program, including new regulations that stabilized the state allotment formula for CHIP. CHIP will undergo a couple of evaluations, one by the federal government, the results of which should be available in 2001, and another by the General Accounting Office (GAO). The GAO plans to study the "problem" of Medicaid-eligible enrollees using CHIP instead of Medicaid. Additionally, the legislation made what Baxendell called a "technical adjustment" to account for the underrepresentation of CHIP enrollees from U.S. territories.

Covering Kids One organization working to identify ways to improve CHIP enrollment is the Covering Kids program. Backed by a $47 million Robert Wood Johnson Foundation grant, Covering Kids assists states and local communities in increasing the number of eligible children in health insurance programs. Sarah Shuptrine, the program's director, said that Covering Kids has three years to accomplish three goals: identifying eligible children through outreach programs; streamlining the application process and coordinating existing coverage programs for low-income children. Forty-nine states and the District of Columbia participate in the program. South Dakota previously declined to participate in the program, but recently has asked permission to reapply. Shuptrine identified some of the obstacles programs like Medicaid and CHIP face in enrolling uninsured children. One problem is the stigma associated with CHIP and Medicaid, especially in an era of welfare reform. Another barrier is that some states have complicated application processes or still employ assets tests that could disqualify an applicant for owning a car or home and often discourage qualified individuals from applying. Shuptrine said employing assets testing is like "shooting yourself in the foot." Covering Kids is examining other barriers to CHIP, such as outdated computer systems, and targeting specific populations including migrant workers, older children, Native Americans and Latinos.

States in Action Some states already have taken steps to increase participation. In Illinois, state officials have enrolled 1.4 million individuals in Medicaid, 800,000 of whom are children. Matt Powers, administrator for the Illinois Department of Public Aid, Division of Medical Programs, noted that those figures are higher than the numbers of individuals the state had enrolled through the defunct Aid to Families with Dependent Children and Temporary Assistance to Needy Families (TANF). State efforts to make both its CHIP and Medicaid program more accessible include a shortened application, an increased number of sites where families can sign up and a stronger mail-in system that can process more than 400 applications each day. The state also has directed efforts at schools, where information is distributed through the free and reduced lunch program and report card days. While Illinois' enrollment numbers have reached about 30% of the target, Powers said there has been better and steadier enrollment as well as a consistent volume of applications. In Maryland, 61,000 children are enrolled in the Maryland Children's Health Program. Ned Wollman, assistant director for the Maryland Office of Eligibility and Administration, praised CHIP for its "ease of access." To simplify the application process, Maryland streamlined its application and eliminated the assets test and face-to-face interviews. Wollman said outreach has been the key to the program's success. The state has gone through schools, churches and other organizations that have contact with children to get the word out. Maryland offers special assistance for CHIP enrollees, who must join one of seven managed care organizations within 20 days after their application is accepted. During that time, outreach workers help enrollees choose which MCO is best for them (Amanda Wolfe, American Health Line, 12/16).

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